Just in time for winter

Long-running conversations about the future of Sundance’s ambulance fleet came to an abrupt end on Thursday when the Crook County Medical Services District Board of Trustees was presented with a possible solution and instantly approved it.

For the last year, the Sundance City Council has been dissatisfied with the traditional arrangement, in which the city owns the ambulances and is responsible for their maintenance and storage. This, according to Mayor Paul Brooks, is a throwback to a time when the hospital district was financially insecure and in need of help.

Times have changed, according to the mayor, who raised the question in 2018 by asking, “Do we, the City of Sundance, belong in the ambulance business?”

This was not the only reason to seek a new way of doing things. According to CEO Nathan Hough, addressing the CCMSD board last week, “We’re down to where we have one reliable rig right now. The other has an electrical issue, we’ve had three people look at it…and nobody can figure out what’s wrong with it.”

The electrical issue does not render the ambulance completely useless. However, it does mean there is no heating in the vehicle, which is problematic going into the winter months.

Hough and his team researched the possibility of leasing an ambulance rather than buying a new one and came to a deal with a company based in Sioux Falls for a lease with a maximum of just $2500 per month with no mileage on top and an option to purchase at the end of the lease.

The company would take care of all major repairs, Hough continued, though the district would be responsible for routine maintenance and insurance. The district would have its pick of ambulances, either new or rebuilt.

It has already been verified that leasing the ambulance will be an operating expense and therefore reimbursable by Medicare and Medicaid, Hough said.

The board was united in its initial response, which was that purchasing an ambulance at the end of the lease would probably not be the best plan.

“Then we fall back into that trap of having old junk again,” said Trustee Mark Erickson.

Hough explained that his negotiations were based on creating as many options as possible. The district will not be obligated to purchase the ambulance, he said, and could instead begin a new lease.

“It’s just an option for us, that’s all it is,” he said.

Chairman Sandy Neiman stated that the board needs to speak with the city about this new plan.

“It appears…that the city kind of wants out of the ambulance business, from what I read,” said Erickson. The option in front of the board is positive, he continued: “The only thing that we would really want to be asking any more from the city…is that [because] we house the ambulances in a surplus city building, how do we continue that relationship?”

Erickson was adamant that there would no longer be a need to involve the city other than to lease space for ambulance storage. “Why do we want to burden them?” he asked.

Neiman explained that the city and county are able to pursue grants, while the district in many cases cannot. For this reason, she said, it is important to preserve the relationship.

Neiman suggested the possibility of presenting all the information to the city and offering to pay them a set amount per month on top of rent to house the ambulances. This could be put away for future ambulance needs and matching funds for grants, she said, or used to heat and maintain the building.

“That would keep our coalition going,” she said.

“We used to pay them so much a year to offset them housing the rigs. I don’t know when that ended, but it shouldn’t, we shouldn’t be getting that for free – not when we’re charging for service.”

Neiman referred to a statement made by the Sundance City Council that city residents are paying for the ambulances, while county residents can make use of the service without having paid through their tax.

“It is a valid argument for these towns,” commented Trustee Joey Kanode.

Kanode pointed out that the cities receive around $4000-5000 from the county as a contribution to the ambulance fleet and service to county residents is expected in return for that “drop in a bucket”. The solution in front of the board would clean things up in terms of fairness, he added.

All board members expressed a keen desire to solve the issue, take responsibility for the ambulances as a district and, as Erickson termed it, become “self-sustaining”.

Equally concerned that the district should have a second working ambulance in place before the winter renders it impossible to use the vehicle without working heat, the board directed Hough to enter into a six-month trial contract immediately. This was approved via a motion and the contract was finalized before the meeting came to an end.

“We will work with the city to resolve the rest of the issues,” said Kanode.

Board members and Hough will speak with the City of Sundance during the work session before the regular meeting on December 3.